Abstract
The Mediterranean diet (Med-Diet) is considered the most effective dietary patterns to obtain weight loss in NAFLD patients. Previous evidence suggested that Med-Diet adherence could reduce cardiovascular risk and have a beneficial effect on NAFLD severity. Aim of the study was to investigate the relationship between Med-Diet adherence, platelet activation (PA), and liver collagen deposition. The study was performed in 655 consecutive NAFLD outpatients from the PLINIO study, a prospective observational cohort study aimed to identify non-conventional predictors of liver fibrosis progression in NAFLD. PA was measured by the serum thromboxane B2 (TxB2), and liver collagen deposition by N-terminal propeptide of type III collagen (Pro-C3). Adherence to the Med-diet was investigated by a short nine-item validated dietary questionnaire. Patients with high Med-Diet adherence were older and had less metabolic syndrome and lower serum triglycerides, GGT, TxB2, and Pro-C3. At multivariate regression analyses, in the linear model, the Med-Diet score negatively correlated with both TxB2 (Beta = −0.106; p = 0.009) and Pro-C3 (Beta = −0.121; p = 0.002) and in the logistic model high adherence inversely correlated with higher TxB2 tertiles (II tertile: OR = 0.576, p = 0.044; III tertile: OR = 0.556, p = 0.026) and Pro-C3 tertile (III tertile: OR = 0.488, p = 0.013). Low consumption of red meat inversely correlated with higher TxB2 tertile (II tertile: OR = 0.448, p < 0.001, III tertile: OR = 0.567, p = 0.004). In conclusion, NAFLD patients with high adherence to the Med-Diet show lower PA and liver collagen deposition, suggesting a protective role of the Med-Diet against NAFLD progression and cardiovascular risk. In addition, the correlation between TxB2 and Pro-C3 suggests a link between NAFLD severity and cardiovascular risk.
Highlights
The Mediterranean Diet (Med-Diet) is one of the most studied diets
Previous studies have demonstrated anti-inflammatory [38] and antioxidant effects in both the general population [39] and Nonalcoholic fatty liver disease (NAFLD) patients [24]. This is the first study proving an inverse correlation between Med-Diet adherence, circulating platelet activation marker, and liver collagen deposition in patients with NAFLD
While impaired lipid profile [42], diabetes [43], endothelial dysfunction [44], and oxidative stress [45,46] were investigated as possible risk factors in NAFLD patients, few studies have addresses platelet activation as a cardiovascular risk marker
Summary
The Mediterranean Diet (Med-Diet) is one of the most studied diets. It is considered a lifestyle approach promoting social exchange, intercultural dialogue, and the respect of diversity [1], favoring environmentally responsible dietary approaches [2] that reduce CO2 consumption [3].The Med-Diet is an eating pattern characterized by plant-based and minimally processed foods; limited consumption of sweets, red meats, and eggs; moderate wine drinking; and high-quality fats intake [4].The Med-Diet was firstly described as the dietary pattern of Mediterranean region who suffered less frequently from cardiovascular disease in comparison to other European and American regions with different dietary habits [5]. The Mediterranean Diet (Med-Diet) is one of the most studied diets. It is considered a lifestyle approach promoting social exchange, intercultural dialogue, and the respect of diversity [1], favoring environmentally responsible dietary approaches [2] that reduce CO2 consumption [3]. The Med-Diet is an eating pattern characterized by plant-based and minimally processed foods; limited consumption of sweets, red meats, and eggs; moderate wine drinking; and high-quality fats intake [4]. The Med-Diet was firstly described as the dietary pattern of Mediterranean region who suffered less frequently from cardiovascular disease in comparison to other European and American regions with different dietary habits [5]. The protective role of the Med-Diet on cardiovascular disease has been confirmed over time by different studies [6,7]. Researchers investigated the different ways by which the Med-Diet exerts its protective role. The Med-Diet is effective in weight-loss process, producing more favorable effects on glycemic control than other diets [8], reduces insulin resistance (IR) [8], is rich in antioxidant nutrients [9], reduces serum inflammation markers [10], and improves endothelial function [11]
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